Mom Shaiyena Currie, right, with 3-day-old baby Octavia and her sister Chelsea Currie on their way home to Bella Coola from Williams Lake after three weeks of living in a tent waiting for the birth. PNG
Three weeks after the birth of her daughter Octavia, Bella Coola mom Shaiyena Currie, 23, is still recovering from the trauma of spending 14 days in a tent during the final stretch of her pregnancy.
Since 2008, when Vancouver Coastal Health cut maternity services at Bella Coola General Hospital, pregnant women in the community must travel to Williams Lake a month before their due date.
Pregnant women who travel for their deliveries in the VCH region are eligible for some discounts on ferries and airfares, and a medical discount of about 30 per cent at select hotels, but meals, accommodation, mileage, fuel and local transportation expenses are not included in the provincial Travel Assistance Program.
Currie estimates that the total cost to her and her family for the birth was around $10,000, in part because her sister had to take an unpaid leave from her job to accompany Currie.
“I was worried for my safety. I stayed up all night tossing and turning because of the fear that anybody could just walk into my tent,” said Currie who pitched her tent at the Stampede Campground, not far from Cariboo Memorial Hospital in Williams Lake.
When a busy horse riding competition started on the stampede grounds, Currie moved to the Stampeder Motel where the slightly discounted medical rate came to $90 a night, plus taxes and fees. The final insult was that she had to give birth alone, because her sister had to watch her son at the hospital while she was delivering. Her mother had planned to be there, but couldn’t make the six-hour drive in time.
Currie calls the whole situation “terrifying and traumatic,” and says people need to know the health and safety risks pregnant women face when travelling to give birth.
Katy Best is a Bella Coola Grade 5 teacher who is expecting her first child will moving back in with her mother in Richmond next week while she awaits her birth.
In a letter to health authorities advocating for change, Best wrote on Aug. 29, “The disruptions to these mothers’ lives are countless, including having to leave children behind or pull them out of school, feeling isolated from their communities and partners at a very vulnerable time, and missing out on nesting at home during their final month of pregnancy.”
Best said she was required to sign a waver stating that she understood childbirth was “inherently dangerous,” and that she would be required to leave the community to give birth.
“If leaving the community is deemed a medical necessity by health authorities, why aren’t the costs covered?”
“This is an equity issue,” says Best, who points out that pregnancy is not a “rare or unforeseeable condition.”
“Based on the fact that you give birth, you have to take on this enormous financial and emotional hardship.”
Best believes that Vancouver Coastal Health saved money by shutting down Bella Coola General’s maternity program, and “off-loaded those costs onto women and families.”
Adrian Dix, Minister of Health told Postmedia in an email, “Improving travel assistance supports, especially for expectant mothers and families, is an issue that I am looking into with the input of Ministry of Health staff and health authorities.”
Vancouver Coastal Health provided Postmedia with a written statement which read in part, “Vancouver Coastal Health recognizes the difficulties in providing health services to residents of remote and rural communities. This issue is not unique to British Columbia, or even to Canada for that matter. Bella Coola Hospital does not have full maternity service.”
A 2013 study published by the Canadian Institute for Health Information said 40 per cent of women living in rural Canada drive more than an hour to give birth; 17 per cent drive more than two hours.
A 2008 report from the Centre for Rural Health Research on Maternity Care in Bella Coola stated that cuts to rural maternity services tend to be driven by a trend toward centralization of health services and challenges in attracting nurse, general practitioner surgeons and specialists and lack of access to specialized services such as “access to epidural anesthesia, labour augmentation, or caesarean section backup.”
It’s not good enough for Currie.
“I don’t want another woman to have to sleep in a tent, or worse. Something needs to be arranged so mothers are safe and can give birth in their communities.”
When wildfire smoke enveloped Metro Vancouver last summer, Nikki Rogers noticed soot collecting on the walls of her White Rock condo and closed her windows to keep the bad air out.
“I tried to stay inside because I did not enjoy being outside,” recalled Rogers, who works in a hair salon. “I would never do any kind of exercising or jogging or walking outside because anything that promotes heavy breathing outdoors would be terrible.”
This summer she will take even greater precautions because she is pregnant. And this is the first year that Vancouver Coastal Health and Metro Vancouver have included pregnant women on their list of people especially vulnerable to wildfire smoke, along with asthmatics, the elderly, and people with chronic heart and lung conditions.
Rogers said she will research the best way to keep herself and her baby safe, but laments that wildfire smoke is one more thing expectant mothers will likely need to worry about this July and August.
“We shouldn’t have months of just smoke in the air. That’s just awful,” she said. “Every year it gets worse and worse. It is just getting out of hand.”
Experts believe British Columbians are about to experience another hot, smoke-filled summer, basing their prediction on the higher-than-average temperatures and drought so far in 2019 — a trend that is expected to continue.
“We expect increased wildfire and smoke risk, and that includes in the southwest where we are,” said a Metro Vancouver air-quality engineer, Francis Ries.
Just in the last week, a stubborn wildfire on steep terrain near Lions Bay snarled traffic on the busy Sea to Sky Highway for days, and a fire broke out Monday near Pender Harbour on the Sechelt Peninsula.
Fires started earlier in 2019
Hotter, drier conditions contributed to fires in early spring, far sooner than in other years. Since April 1, the B.C. Wildfire Service has recorded 377 fires that have burned more than 110 square kilometres.
The summers of 2017 and 2018 were the worst on record for smoky skies — a provincial state of emergency was declared both years over wildfires — and much of the haze in Metro Vancouver drifted in from big fires in other parts of B.C.
The smoke led officials to issue a record number of air-quality advisories, and give extensive advice on how residents should try to remain healthy.
This year, local health and municipal agencies added pregnant women to the list of those most vulnerable to the smoke after lobbying by Sarah Henderson, an environmental health scientist at the B.C. Centre for Disease Control.
She advocated the change based on an “evidence review” and academic research that showed mothers exposed to extreme wildfire smoke give birth to smaller babies.
A University of California, Berkeley study found that pregnant women breathing in wildfire smoke during their second trimester in 2003, a terrible fire season in Southern California, had babies that were about 10 grams lighter than women not exposed to smoke. The results were small but “significant,” researchers found, because they showed “climate change can affect health.”
Ten grams would be enough to “push some babies into a low-birth-weight category,” added Henderson, noting undersized infants can face challenges.
Based on pregnancy and population statistics, Henderson predicts a repeat of last summer’s smoky skies could lead to 20 babies in B.C. being born a bit smaller. It’s not a big number, but one that could hurt 20 families.
“And that is kind of the tip of the iceberg in some ways because nobody has looked at preterm birth or malformations, if that smoke exposure happens to pregnant women,” added Henderson, who is also an associate professor in the UBC school of population and public health.
She has applied for funding to do her own study of the outcome of women who were pregnant in B.C.’s Interior, where the smoke was the thickest during the last two summers.
Wildfire smoke is a toxic, chemical soup
Wildfire smoke contains many pollutants, but the most dangerous to human health is fine particulate matter, a mixture of solid particles and liquid droplets that are generally 2.5 micrometers or less in size — about one-30th the diameter on a strand of hair.
“The very small particles can be inhaled deeply into your lungs and then get into your blood stream, and irritate and lead to inflammation,” said Emily Peterson, a Vancouver Coastal Health environmental health scientist.
A typical summer day in Metro Vancouver would feature 10 or 15 micrograms a cubic metre of these fine particulates, but during the height of last summer’s smoky skies the quantity jumped tenfold.
Smoky air makes it harder for lungs to get oxygen into the blood stream, and it can irritate the respiratory system and cause inflammation in other parts of the body. Common symptoms include eye irritation, sore throat, coughing, wheezy breathing and headaches, and there is an increased risk of infections for some, such as pneumonia in older people and ear infections in children.
At-risk people — including those with chronic lung or heart conditions and now pregnant women — should “pay attention to the smoke much earlier” this summer, said the VCH medical health officer, Dr. James Lu.
“We do start with the vulnerable population, but if the smoke (concentration) is high enough we do encourage people who are normally healthy to take precautions as well,” Lu added.
Among the precautions backed by medical experts: Stay inside places with filtered air, such as most community centres, libraries or malls; drive with the windows up, the air conditioning on, and the recirculate-air button activated to reduce the amount of smoke getting into your car; and drink lots of water.
Because most people typically spend 90 per cent of their days indoors, Henderson highly recommends buying a portable air cleaner, which plugs into a wall socket and can be moved from room to room. These purifiers remove 40 to 80 per cent of the fine particles found in smoke, but people with respiratory conditions are encouraged to buy higher-performing HEPA (High Efficiency Particulate Air) filters, the Centre for Disease Control says.
If people are outside and want to wear a mask, Henderson said the best option is a well-fitted N95 respirator. A surgical mask can offer limited protection. A cloth mask is close to useless at keeping out the fine particles in smoke.
Doctors’ visits, asthma prescriptions skyrocket
Most people can manage irritations from smoke without medical attention, but those with severe symptoms should see a doctor.
Wildfire smoke caused a slight rise last summer in the number of people visiting Vancouver Coastal Health emergency rooms, although the increase wasn’t even across all communities: North Vancouver and Richmond had more hospital visits, while other cities did not, said Lu.
“What we did see were increased visits with respiratory symptoms, asthma and people short of breath,” the medical health officer told Postmedia.
The B.C. Health Ministry could not provide information about higher traffic in emergency rooms in other health regions, saying its data does not let it differentiate between treatment specifically for wildfire smoke and other respiratory issues.
However, Centre for Disease Control statistics suggest medical services across B.C. were harder hit when wildfire smoke was heavy. In the summers of 2017 and 2018, 45,000 extra doses of asthma medication were dispensed and there were 10,000 extra visits to doctors for asthma-related conditions in B.C., Henderson said.
“It does stack up, the impact is quite extreme,” she said. “On a very smoky day in Metro Vancouver, there were 350 extra doctor visits.”
The Centre for Disease Control tabulates this information daily in the B.C. Asthma Prediction System, which was launched after previous severe wildfire seasons. The surveillance system tracks asthma-related doctor visits and the prescriptions filled for lung conditions, and is used to warn health officials about the anticipated effects of wildfire smoke.
This summer is also expected to experience a boost in asthma treatments, given what happened in May after a significant wildfire near Fort St. John. “We had this one day of smoke in Fort St John, and the asthma visits skyrocketed,” Henderson said.
During the past few years, Vancouver Costal Health has sent reminders to family physicians to help their patients get ready for smoke expected in July and August — such as ensuring medications for patients with chronic heart or lung disease are up to date.
“I think what we are hoping for is to perhaps educate the public and primary-care physicians in helping people to be prepared so that they don’t really need to come to the emergency,” Lu said.
More than 3,000 ‘smoky skies’ bulletins issued
The provincial Environment Ministry issues “smoky skies” warning bulletins when wildfire smoke gets bad in all areas of the province except Metro Vancouver, which releases its own air quality advisories.
In 2017, 1,646 air-quality advisories were issued across B.C., and that jumped to 1,742 in 2018. There have been 69 warnings so far this year, but that number will likely increase as the majority of 2018 bulletins were issued between late July and late August.
The province monitors 63 regions, and six of those have had 100 or more smoky skies bulletins since 2017 due to bad fires nearby, including Quesnel, Penticton, Prince George, Williams Lake and Kamloops. Other communities in B.C.’s Interior and the Cariboo region have also been hard hit, with just under 100 bulletins issued in the last two years in Vernon, Kelowna, Cranbrook and 100 Mile House.
Only Haida Gwaii, off B.C.’s northwest coast, has had no smoke-related air quality warnings since 2017.
The Environment Ministry was unable to provide information about how many advisories it issued in years with far fewer forest fires than 2017 and 2018. But statistics from Metro Vancouver indicate those two years were off the charts.
There were 22 days in Metro Vancouver last summer with poor air quality due to forest fires, mainly between late July and late August. In 2017, it was 19 days of unhealthy amounts of smoke.
The region’s figures, dating back to 1996, showed no other years with near that number of hazy days, the closest being 10 days in 2009 and 2015, when there were also some forest fires. In several years, including 2011, 2013 and 2016, there were no days with poor air quality.
Metro Vancouver’s advisories show much of the air pollution came from forest fires in other parts of the province, but the air was also affected by some local blazes, such as a bog fire in Richmond and a barge blaze in Surrey.
No air quality advisories have been issued so far in 2019; Metro Vancouver said the smoke residents smelled earlier this week from the Lions Bay fire was “below advisory thresholds.”
Some smoke from the Strip Creek wildfire south of Lions Bay has reached western portions of Metro Vancouver. Air quality levels remain below advisory thresholds however concentrations may vary as winds and wildfire behaviour changes. https://t.co/qyfTAdCeW5
Metro Vancouver’s summer 2019 outlook warns of the potential for increased ozone due to higher temperatures and wildfires. Ozone is described as “good up high; bad nearby” — ozone in the atmosphere protects from UV radiation, but when lower to the ground it damages lungs and destroys ecosystems according to a Colorado State University academic paper, Ozone Levels Elevated in Presence of Wildfire Smoke.
“We’ve seen high ozone levels at monitoring stations which we never, under normal circumstances, expect to have high ozone,” said Metro Vancouver’s Ries. “We almost never have high ozone in the western part of the valley, downtown Vancouver and through into Burnaby,” he said, except in 2017 and 2018 when “the highest ozone levels we received were in that part of the region.”
Ries said more studies, including ones that focus on B.C., are making a strong link between climate change and the exacerbation of wildfire seasons.
In 2017, 65,000 British Columbians were evacuated and 509 buildings burned during wildfires that scorched 12,000 square km of land. The 2018 forest fires were even more destructive, consuming 13,500 sq. km — although fewer people were evacuated (6,000) and fewer structures lost (158).
Over the last two summers, the provincial government grossly outspent its wildfire budgets — by 10 times in 2017, when it cost more than $650 million to fight the fires. This year, the NDP is trying to be better prepared for the unknown by nearly doubling its wildfire budget, boosting it from $64 million in 2018 to $101 million.
Smoky summers in Vancouver may become “the new normal,” if not every year then at least every other year, VCH’s Lu predicted.
“We do not expect this to go away. This is going to be a way of life, unfortunately,” he said. “So I think the need to include that in your consideration of how to stay healthy is important.”
Chilliwack Mayor Ken Popove has requested a meeting with Health Minister Adrian Dix to express his concerns about the temporary closure of Chilliwack Hospital’s maternity ward. Francis Georgian / PNG
The mayor of Chilliwack is requesting a meeting with B.C. Health Minister Adrian Dix to express concerns about a plan to close the maternity ward at Chilliwack Hospital for an indeterminate amount of time starting later this month.
The closure is caused by an “unexpected shortfall in obstetricians,” said Jennifer Wilson, medical director for Chilliwack Hospital. Due to a medical leave, the hospital is no longer able to ensure there is an on-call obstetrician available for emergency interventions and C-sections at all times.
Fraser Health is working on a plan to address the problem, but women who expected to give birth in Chilliwack after June 24 will have to go to Abbotsford Regional Hospital instead, said Wilson. “Our goal is to be up and running again as soon as possible.”
The doctor said the decision to close the maternity ward was not made lightly and she “respects” the concerns of women who are now faced with travelling outside their community to deliver. “We are really committed to making things as safe as possible for women.”
But Chilliwack Mayor Ken Popove said it is “insane” that his community of 100,000 people will not have a maternity ward this summer. On average, there is between one to two births per day at Chilliwack Hospital.
“I understand that it’s difficult (for Fraser Health), but there should have been a plan in place,” he said.
The mayor said he is asking for a meeting with the provincial health minister to discuss the situation. He has also spoken to the mayor of Hope who is worried about the health of women who will have to travel more than an hour — possibly in rush-hour or long-weekend traffic — to reach the hospital in Abbotsford.
“It’s an hour on a good day. What happens if there’s an accident?” asked Popove.
The mayor said he hasn’t been told when Fraser Health plans to reopen the maternity ward. But he has been hearing from families in his community who are worried and anxious.
Former Chilliwack mayor and B.C. Liberal MLA John Les called the closure “a kick in the head” in response to a Chilliwack Progress news story about the closure.
“This is a bloody outrage,” he said in a Facebook post.
“If implemented, this two- to three-month suspension of deliveries will become permanent,” he speculated. “This has been Fraser Health’s dream all along: centralize everything in Abbotsford.”
Wilson said the hospital plans to maintain its maternity ward and is looking for long-term solutions to the staffing problem. It is also working to address transportation concerns from women who may have trouble reaching Abbotsford.
“We have reassurances from Abbotsford … (that) they have the capacity,” she said.
But registered midwife Libby Gregg said the closure is making women “fearful” about their deliveries.
“They are really suffering,” she said, explaining that some women will lose the doctor who has cared for them through their entire pregnancy because the doctor doesn’t have hospital privileges at the Abbotsford hospital.
“These women will be in an unfamiliar situation with people they don’t know,” she said.
Gregg said an increase in stress and anxiety in the late stages of pregnancy and during delivery can have negative impacts on mothers and babies, including a possible increase in inductions and C-sections.
“The implications are huge and far-reaching.”
Gregg said Chilliwack midwives are stepping up to offer their services to women who are scrambling to find a caregiver ahead of the closure, adding “we’re here to support as many families as we can.”
Prescribed pills to treat HIV. Jenelle Schneider Jenelle Schneider / PROVINCE
HIV-positive mothers with at least one child give birth to more babies than HIV-negative mothers, a new B.C. study spanning the years from 1997 to 2015 shows.
The analysis of live births published in a medical journal called PLOS One shows that among women who have already given birth, HIV-positive mothers have on average more children than a control group of HIV-negative mothers. The trend applies across all ages.
In the study span, there were a total of 669 live births among 270 HIV-positive women aged 15 to 49 and 1,577 births to 871 HIV-negative controls. The birth rate for HIV-positive women aged 15 to 24 was 1.88 live births per woman, while in the HIV-negative control group it was 1.52 per woman.
In the 25 to 34-year-old age group, the birthrate among women living with HIV was 2.62, compared to 1.76 in a HIV-negative control group. And in the 35 to 49-year-old category, the birthrate among HIV-positive mothers was 2.58, versus 2.11 in the HIV negative group.
The majority of HIV-positive women across Canada are in their reproductive years, and previous research has shown that motherhood is important to them.
There was an average of about 42,700 births annually to all women in the province during the study’s 1997 to 2015 time period. Babies born to HIV-positive women represented 0.05 per cent of all the births over the term of the study.
A study published in 2017 and based on a large group of Canadian women with HIV, showed that nearly a quarter of them between 2013 and 2016 got pregnant, but 60 per cent of such pregnancies were unintended. The new study did not look at whether pregnancies were planned.
There are about 1,200 women and 6,100 men living with HIV in B.C.
The Oak Tree Clinic at B.C. Women’s Hospital specializes in care for women and children with HIV, but the study’s authors say females with HIV need access to comprehensive reproductive health care, whether they live in urban areas like Vancouver or rural and remote areas.
Hélène Cote, a co-author, and researcher at the Women’s Health Research Institute at B.C. Women’s Hospital, said in an interview that the vast majority (over 80 per cent) of women living with HIV in Canada are receiving treatment, and most are attaining viral suppression success on such treatment. She said there has never been a baby born in B.C. to a woman aware of her HIV status and on such treatment during her pregnancy.
Cote said the fact that young women with HIV are having more babies would suggest they are conceiving at younger ages because of socio-cultural factors, in addition to feeling secure knowing that while on treatment, their risk of transmitting HIV to their baby is “almost zero.”
“Primary care physicians in communities across B.C. must not assume young woman are not having unprotected sex. And when they have HIV-positive patients, they must counsel them about sexual and reproductive health, including contraception, pregnancy plans, desires, and risks, among many other things. When a 17-year-old with HIV goes to a doctor and says, ‘I want to get pregnant,’ appropriate health care is required to ensure a safe pregnancy,” she said.
Women account for 18 per cent of all HIV cases in B.C., and since many have been on anti-retroviral treatment for a long time, researchers were keen to learn whether birth rates were going up over time for women in various age groups. Cote said for those aged 25 to 49, they found that as time went on, they did, suggesting women with HIV are “increasingly likely to feel confident about bearing children later in life.”
“The results of this study are an important step toward further understanding the reproductive health trends of women living with HIV, especially now that (they) can have pregnancies with little or no risk of … transmitting HIV to their child if engaged in care and appropriately treated,” says the study, funded by the Canadian Institutes of Health Research.
Previous research showed associations between HIV infection and lower childbirth rates in low- and middle-income countries, while the latest study is among the few done on women in high-income jurisdictions.
Researchers at the University of B.C. have found that some women don’t consider cannabis a drug and believe it’s OK to light up a joint while pregnant.
The review of six U.S. studies, published in the journal Preventative Medicine, found that an alarming number of women, around one-third, don’t think cannabis could harm their baby.
That’s despite warnings from obstetricians not to consume cannabis during pregnancy and while breastfeeding, and studies that have linked pot with a higher chance of anemia, low birth weight, and stillbirth.
Although the UBC researchers analyzed U.S. data for their report, published in the journal Preventative Medicine, they say the information is relevant for health care providers in Canada, where consuming marijuana for recreational use became legal last year.
Lead author Hamideh Bayrampour, assistant professor in the UBC department of family practice, said they couldn’t find similar studies in Canada likely because of ethical issues. She said there is a need for more Canadian data on the topic.
The concern, said Bayrampour, is that many women surveyed perceived a lack of communication from their health care providers about the risks of cannabis as an indication that the drug is safe to use during pregnancy.
“This is important because if they don’t perceive harm they are more likely to use cannabis,” she said.
“What we know for sure is that we don’t know yet whether cannabis is safe to use in pregnancy, although there is evidence emerging that if a women uses cannabis their baby might be smaller than average.”
She said it would be beneficial here for health care providers to have a discussion with patients about cannabis, just as they do now with alcohol or cigarettes.
Some women surveyed said they smoked pot while pregnant to cope with an illness, such as depression or anxiety, instead of taking stronger pharmaceutical drugs, while others identified cannabis as a way to deal with the nausea of morning sickness.
“If they are choosing between cannabis and a sedative for pain they perceive cannabis as a safer choice,” said Bayrampour.
The UBC review shows pregnant cannabis users were more likely to be under the age of 25 and to have low income and education, or use other substances such as tobacco and alcohol.
In one study, women were asked about their perception of general harm associated with cannabis use, 70 per cent of both pregnant and non-pregnant cannabis users responded that they perceived slight or no risk of harm.
“I think we need to have a question specifically related to cannabis similar to alcohol. We need to provide a safe, non judgmental environment to talk about this,” said Bayrampour. “It is a great opportunity for caregivers to start this conversation and motivate and support them in their decision to quit.”
The Society of Obstetricians and Gynaecologists of Canada recommend women not use cannabis when trying to conceive, during pregnancy and while breastfeeding.
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